RESUMEN
BACKGROUND: Transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) are used for the clinical diagnosis of adenomyosis. OBJECTIVES: To compare the diagnostic accuracy of TVS and MRI for the diagnosis of adenomyosis. SEARCH STRATEGY: A search of studies was performed in five databases comparing TVS and MRI for the diagnosis of adenomyosis from January 1990 to May 2022. SELECTION CRITERIA: Studies were eligible if they reported on the use of TVS and MRI in the same set of patients. The reference standard must be pathology (hysterectomy). DATA COLLECTION AND ANALYSIS: The quality of studies was assessed using the QUADAS-2 tool. Pooled sensitivity and specificity of both techniques were estimated and compared. MAIN RESULTS: Six studies comprising 595 women were included. The risk of bias of patient selection was high in three studies. The risk of bias for index tests and reference test was low. Pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for TVS were 75%, 81%, 3.9, and 0.31, respectively. These figures for MRI were 69%, 80%, 3.5, and 0.39, respectively. No statistically significant differences were found (p = 0.7509). Heterogeneity was high. CONCLUSIONS: MRI and TVS have similar performances for the diagnosis of adenomyosis.
Asunto(s)
Adenomiosis , Endometriosis , Humanos , Femenino , Adenomiosis/diagnóstico por imagen , Endometriosis/diagnóstico , Ultrasonografía/métodos , Imagen por Resonancia Magnética/métodos , Histerectomía , Sensibilidad y EspecificidadRESUMEN
Sclerostin, encoded by the SOST gene, works as an inhibitor of the Wnt pathway and therefore is an important regulator of bone homeostasis. Due to its potent action as an inhibitor of bone formation, blocking sclerostin activity is the purpose of recently developed anti-osteoporotic treatments. Two bone-specific transcription factors, RUNX2 and OSX, have been shown to interact and co-ordinately regulate the expression of bone-specific genes. Although it has been recently shown that sclerostin is targeted by OSX in mice, there is currently no information of whether this is also the case in human cells. We have identified SP-protein family and AML1 consensus binding sequences at the human SOST promoter and have shown that OSX, together with RUNX2, binds to a specific region close to the transcription start site. Furthermore, we show that OSX and RUNX2 activate SOST expression in a co-ordinated manner in vitro and that SOST expression levels show a significant positive correlation with OSX/RUNX2 expression levels in human bone. We also confirmed previous results showing an association of several SOST/RUNX2 polymorphisms with bone mineral density.
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Proteínas Morfogenéticas Óseas/metabolismo , Huesos/metabolismo , Subunidad alfa 1 del Factor de Unión al Sitio Principal/metabolismo , Factor de Transcripción Sp7/metabolismo , Proteínas Adaptadoras Transductoras de Señales , Densidad Ósea/fisiología , Regulación de la Expresión Génica/genética , Marcadores Genéticos , Humanos , Osteoblastos/metabolismo , Osteogénesis/fisiología , Regiones Promotoras Genéticas/genéticaRESUMEN
OBJECTIVE: The aim of the study was to estimate whether POP severity is related to lower urinary tract symptoms (LUTS) and symptoms of sexual difficulties, when evaluated with validated questionnaires. STUDY DESIGN: Multicentric cross-sectional study of 521 women seeking care for PFD in 35 specialized urogynecological clinics. Patients answered the EPIQ to detect symptoms of PFD. The severity of urinary incontinence and the OAB symptoms were measured by ICIQ-UI SF and BSAQ. POP anatomic severity was measured by the anatomic stage of each compartment, determined in pelvic examination in accordance with the IUGA-ICS terminology. A maximum POP stage (M-POP-S) was assigned to each patient: Group A, patients with no POP (stage 0-I); group B, M-POP-S stage II; and group C, M-POP-S stage III-IV. RESULTS: Pelvic examination demonstrated anatomic POP in 224 patients (stage from II to IV). 288 women (56.25%) were classified in group A (no prolapse); 102 (19.92%) group B (stage II); and 122 (28.83%) group C (stage III-IV). Several associations were found between studied variables and M-POP-S (age<55 years, menopause, number of vaginal deliveries, symptom of vaginal bulge, feeling of a bulge makes it difficult to have sexual relations, symptoms of stress urinary incontinence, nocturia and voiding difficulties), but the only variables independently associated were age, symptom of vaginal bulge and difficulty in having sexual relations due to feeling of a bulge. CONCLUSIONS: In patients seeking care for PFD, LUTS are not independently associated to the prolapse stage.
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Trastornos del Suelo Pélvico/complicaciones , Prolapso de Órgano Pélvico/complicaciones , Índice de Severidad de la Enfermedad , Factores de Edad , Anciano , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Prolapso de Órgano Pélvico/patología , Disfunciones Sexuales Fisiológicas/etiología , Encuestas y Cuestionarios , Vejiga Urinaria Hiperactiva/etiología , Incontinencia Urinaria de Esfuerzo/etiología , Enfermedades Vaginales/etiología , Enfermedades Vaginales/patologíaRESUMEN
PURPOSE: The purpose of this study was to investigate the intraobserver and interobserver agreements in the diagnosis of malignant versus benign adnexal masses using two-dimensional ultrasonography (2D US) and three-dimensional ultrasonography (3D US). METHODS: Two experienced sonographers performed a retrospective review of digitally stored 2D images and 3D data from a sample of 41 consecutive patients with a diagnosis of adnexal mass. Each observer independently, and blinded to each other, evaluated the 2D static images of each adnexal mass and then the 3D volumes 1 week later. The observers were required to classify the adnexal lesion as benign or malignant according to pattern recognition analysis. Intraobserver and interobserver agreement were assessed by calculating the kappa index (κ). RESULTS: Intraobserver agreement between 2D US and 3D US for the observer A was 1.00 and for the observer B was 0.69. Interobserver agreement was 0.69 for 2D US and 1.00 for 3D US (p > 0.05) CONCLUSIONS: Although 3D US in the diagnosis of adnexal masses appeared more reproducible than 2D US, the difference was not statistically significant.
Asunto(s)
Enfermedades de los Anexos/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Enfermedades de los Anexos/patología , Adulto , Competencia Clínica , Diagnóstico Diferencial , Femenino , Humanos , Imagenología Tridimensional , Variaciones Dependientes del Observador , Neoplasias Ováricas/patología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Ultrasonografía DopplerRESUMEN
OBJECTIVE: Secretory changes in endometrial hyperplasia are uncommon. The aim of this study is to review the morphologic and clinical findings of 24 cases of endometrial hyperplasia with secretory changes. METHODS: In 24 patients diagnosed with endometrial hyperplasia with secretory changes during 6 years, clinical characteristics such as menopausal status and hormone treatment were correlated with morphological features. A matched age control group of 24 women with conventional endometrial hyperplasia was used to compare the hormonal effect. RESULTS: Nineteen patients were premenopausal. Nine women showed simple hyperplasia without atypia and 15 complex hyperplasia, 7 of them with atypia. Seventeen women were under hormonal treatment at the time of diagnosis, 10 of them with progestins. In 7 patients endometrial adenocarcinoma could be seen, 5 coexisting with endometrial hyperplasia with secretory changes and in 2 appearing after 1 and 4 months. In control group only 2 patients were undergoing progestin hormonal treatment. CONCLUSIONS: Secretory changes can be found in hyperplastic endometrium, particularly in premenopausal women under hormonal treatment with progestins, with the risk of misdiagnosis.